Good question. It's possible. Some states that have the in-person exam requirement appear to only require a single in-person meeting to establish a bona fide patient-provider relationship such that the provider can later treat and prescribe remotely, rather than require an in-person exam every time the provider wants to treat or prescribe. It really depends on the state's requirement for establishing a bona fide patient-provider relationship. Your example also implicates NP and PA scope of practice issues. For example, if the PA meets with the patient and the PA does not have prescriptive authority under state law, can the PA establish a bona-fide patient-provider relationship that would allow the physician to prescribe remotely? Finally, there may be physician collaboration/supervision requirements under state law that require the physician to actually be on site supervising the PA or NP.

Thanks for your question Lorna. Supporters of the in-person exam requirement would argue that (1) a provider (physician, NP, etc.) cannot accurately assess a patient's health care needs without physically observing the patient in person; and (2) as you note, requiring an in-person exam serves to prevent online "drug mills," which usually presribe lifestyle drugs like viagra to massive numbers of patients based on an online questionnaire completed by the patient and with no interaction (not even by phone or email) between the prescriber and the patient. Many of the legitimate online care models are used to treat low-level conditions like the flu, acne, etc. -- conditions that shouldn't require an in-person examination, particularly with the use of sophisticated online questionnaires and remote interactions with the practitioner (whether by phone, email, or video conference).

David, great question. The biggest hurdle faced by providers seeking to engage in remote consultations is the requirement under many state laws that a patient-provider relationship be established by an in-person, face-to-face encounter. There are workarounds for most of the other hurdles, e.g., corporate practice of medicine laws. If the provider's IT infrastructure is secure, the benefits of providing patients greater and more efficient access to health care, far outweighs any risk of breaching patient privacy. HealthPartners' virtuwell is an excellent example of a highly sophisticated and secure online care model. If states would abolish the requirement of the in-person meeting, that would be a huge step in paving the way for more remote care delivery.

Alex, you're absolutely correct that the rollout process for medical apps is extremely complicated given the lack of a standardized set of rules. I think a standardized set of federal laws would be a step in the right direction but even if a standardized set of federal laws is established, providers and e-health businesses will continue to face conflicting state laws. It's possible though that if a standardized set of federal laws is established, that states may simply incorporate those by reference into their own laws, like some have done with respect to HIPAA.

I've seen issues with online prescriptions and apps. With each state having different laws, the rollout process for some medical apps is extremely complicated. I wonder if we'll ever see standardized federal laws about this.

As InformationWeek Government readers were busy firming up their fiscal year 2015 budgets, we asked them to rate more than 30 IT initiatives in terms of importance and current leadership focus. No surprise, among more than 30 options, security is No. 1. After that, things get less predictable.